Mutation Testing and Adjuvant Systemic Therapy in Cutaneous Melanoma
Several new adjuvant systemic therapy options for adjuvant treatment of stage III melanoma were added to the melanoma guidelines in v2018, such that there are now multiple adjuvant systemic therapy options in some settings. Due to the various entry criteria for these trials and the results from subgroup analyses, the fact that the AJCC staging was updated to the 8th Edition10,11 (since the adjuvant treatment trials were conducted) and the update integrated into the guidelines, and the finding that CLND may not be necessary for patients with SLN positivity, developing cohesive pathways for treatment of stage III and resectable stage IV disease is a non-trivial task. The end-result of much discussion among the NCCN panel is that recommended adjuvant treatment options and categories of recommendation vary according to sub-staging and other patient- and case-specific characteristics, and community clinicians could benefit from explanation of the logic and nuance of these recommendations by NCCN panel experts. Selection among the recommended adjuvant treatment options is a topic of much debate and emerging changes in clinical practice among clinicians at member institutions. Because BRAF/MEK inhibitor combinations are among the recommended options for patients with BRAF V600 mutations, and because of the recent emergence of multiple mutation testing products, there is much debate about the timing and selection assays for mutational testing in patients with melanoma.
This information was originally presented at the NCCN 2019 Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ held in Orlando, Florida, March 21-23, 2019.
This educational program is designed to meet the educational needs of the interprofessional oncology care team, including: physicians/oncologists, nurses, physician assistants, pharmacists, and other healthcare professionals who manage patients with cancer.
Following this program, participants should be able to:
- For patients with a positive sentinel lymph node biopsy, explain the pros and cons of CLND versus active observation, and identify factors to consider when selecting between these treatment options.
- For patients with stage III melanoma and clinically positive lymph node(s), review factors to consider when choosing among the recommended systemic adjuvant treatment options, and the eligibility criteria for patients to receive each of these agents (per the NCCN Guidelines).
- For patients with stage III melanoma with clinical satellite or in-transit metastatic disease, describe the adjuvant treatment options, eligibility criteria for each (per the NCCN Guidelines), and factors to consider when choosing among the recommended options.
Anthony J. Olszanski, MD, RPh
Fox Chase Cancer Center
NCCN Medical Education Disclosure Policy
It is the policy of NCCN that every 12 months, all faculty, moderators, activity planners and all internal planning staff participating in NCCN continuing education activities are expected to disclose any financial relationships with a commercial interest as defined by the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. In addition, all faculty presentations have been reviewed for adherence to the ACCME’s Standards for Commercial Support (the provider develops activities/educational interventions independent of commercial interests [SCS 1, 2 and 6] by experts on the topics).
Per the ACCME Standards for Commercial Support, individuals who do not disclose relevant financial relationships will be disqualified from involvement in the CE activity as a content developer, planner, or presenter. A complete list of individuals’ relationships with external entities is available upon request.
NCCN continuing education considers financial relationships to create a “conflict of interest” when an individual has both a financial relationship with a commercial interest and the opportunity to affect CE content about the products or services of a commercial interest with which he/she and/or a spouse or partner has a financial relationship.
NCCN continuing education considers “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. NCCN does not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship.
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.
Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.
The faculty listed below discloses the following relevant financial relationships:
Anthony J. Olszanski, MD, RPh
EMD Serono: Honoraria
Merck & Co., Inc.: Honoraria
Novartis Pharmaceuticals Corporation: Honoraria
Pfizer Inc.: Honoraria
NCCN Staff Disclosures
The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Robert W. Carlson, MD; Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa G. Kimbro, MBA, CPA (Employed by NCCN until 8/10/18); Wui-Jin Koh, MD; Joan S. McClure, MS (Employed by NCCN until 8/1/18); Lisa Perfidio, MS; Sarah Sinclair; Kathy Ann Smith, CHCP; Gary J. Weyhmuller, MBA, SPHR
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Anita M. Engh, PhD; Nicole R. McMillian, MS
In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
NCCN designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NCCN designates this educational activity for a maximum of 0.67 contact hour.
NCCN designates this knowledge-based continuing education activity for 0.75 contact hour (0.075 CEUs) of continuing education credit. UAN: JA4008196-0000-19-053-H01-P
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credit. Approval is valid until March 1, 2020. PAs should only claim credit commensurate with the extent of their participation.
- 0.75 AAPA Category 1 CME credit
- 0.75 ACPE contact hours
- 0.75 AMA PRA Category 1 Credit™
- 0.67 ANCC contact hours
- 0.75 Participation
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